The Relationship Between Time of Onset of Central Line-Associated Bloodstream Infections and Microbiology Open Access

Abstract

Central lines are important in medical care for the infusion of fluids, medications, and hemodynamic monitoring, but can result in a central line-associated bloodstream infection (CLABSI). Prevention efforts have been effective at lowering the rates of CLABSI, but these insertion event focused changes may have a greater impact on skin-related organisms that cause infection at the time of infection. This study investigated if the time to onset of infection predicted the microbiology of CLABSI (skin organisms compared to organisms not commonly found on the skin).

Data from a previous prospective longitudinal study involving two university hospitals were analyzed. There were 106 CLABSIs due to one or more skin organisms (coagulase-negative staphylococcus, Staphylococcus aureus, or Candida) or due solely to non-skin organisms: gram-negative bacilli, Enterococcus, or other non-staphylococcal gram positive bacteria). The primary predictor, time of onset was dichotomized as early (≤7 days) and late (>7 days). Potential risk factors including sex, hospital, catheter type, subclavian vein insertion site, and infection attributable to the intensive care unit, ICU, were also investigated.

Subclavian vein insertion site was associated less with skin organisms than non-skin organisms (OR 0.25, 95% CI: 0.07, 0.91). Skin organisms were more associated with the hospital with the larger cancer and transplant population (OR 3.10, 95% CI: 1.27, 7.53). Skin organisms were not significantly associated with an early time to onset of infection (OR 1.10, 95% CI: 0.50, 2.44).

The subclavian vein site was found to have a lower OR of a CLABSI from a skin organism compared to other insertion sites, unsurprisingly as sites of the femoral and internal jugular vein have been associated with higher rates of overall CLABSI and tend to have more skin organism colonize at those locations. Early time to onset of infection was not found as a significant difference between the skin and non-skin organisms, possibly because overlap exists where skin organisms also may colonize the hub, leading to infections that are intraluminal and later time to onset.

Table of Contents

Table of Contents:

Introduction: pg. 1

Background: pg. 4

Methods: pg. 13

Results: pg. 17

Discussion: pg. 21

Strengths and Limitation: pg. 24

Future Directions and Public Health Importance: pg. 25

References: pg. 27

Tables: pg. 33

Table 1a

Table 1b

Table 2a

Table 2b

Table 3a

Table 3b

Table 4a

Table 4b

Figure: pg. 41

Figure 1

Appendix: pg. 42

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Biology, Microbiology Health Sciences, Epidemiology
Keyword	Healthcare acquired infections Central line-associated bloodstream infections
Committee Chair / Thesis Advisor	McGowan Jr., John E, Emory University
Committee Members	Jacob, Jesse Thomas, Emory University Steinberg, James Paul, Emory University
Partnering Agencies	Hospital or other health care provider

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